[Indications and surgical strategy for bowel resection in mesenteric ischemia : Resection margins considering current guidelines and literature as well as the influence of new technical possibilities].

Acute mesenteric ischemia (AMI) is still a time-critical and life-threatening clinical picture. If exploration of the abdominal cavity is necessary during treatment, an intraoperative assessment of which segments of the intestines have a sufficient potential for recovery must be made. These decisions are mostly based on purely clinical parameters, which are subject to high level of uncertainty.

Prognostic factors for the long term outcome after surgical celiac artery decompression in MALS.

Background: The median arcuate ligament syndrome (MALS) is a rare disease caused by compression of the celiac artery (ORPHA: 293208). Surgical treatment of MALS aims to restore normal celiac blood flow by laparoscopic celiac artery decompression. However, surgical success rates vary widely between patients, therefore adequate selection of patients is essential to improve surgical outcome.

Visceral artery aneurysms: evolving interdisciplinary management and future role of the abdominal surgeon.

Background: Visceral artery aneurysms (VAA) are rare vascular lesions. Clinically silent VAA are increasingly detected by cross-sectional imaging but some lesions are at risk for rupture with severe bleeding. The aim of the present study was to evaluate the trends in the interdisciplinary management at a tertiary center.

[Current and Future Role of Vascular Surgery Expertise for Visceral Surgeons - an Expert Survey].

Background: Due to improved surgical techniques and safer perioperative management, there has been an increase in radical abdominal and oncological operations. Simultaneous vascular interventions are increasingly necessary - either after preoperative planning or after an intraoperative vascular emergency. It is unclear whether German visceral surgeons have the required vascular surgical skills.

[Vascular Complications and Emergencies within Oncologic Abdominal Surgery - What Knowledge and Skills Are Essential for the Visceral Surgeon].

Continuous improvements in perioperative and neoadjuvant therapy concepts nowadays permit more extensive tumor resections with curative intention. In patients with arterial or venous tumour involvement in preoperative imaging, physicians with expertise in vascular surgery should be involved in the planning phase of the operation. Unexpected vascular complications during abdominal surgery demand prompt management by the oncological surgeon.

Axillobifemoral Bypasses: Reappraisal of an Extra-Anatomic Bypass by Analysis of Results and Prognostic Factors.

Background: Axillobifemoral bypass (AFB) is method of second choice. It is reserved for patients at high operative risk or to bypass infected vessels or grafts. In this study, we analyzed prognostic factors for AFB patency and limb salvage rate to facilitate the choice of procedure.

[Ruptured Abdominal Aortic Aneurysm - Results and Prognostic Factors at a Certified Centre of Vascular Surgery].

Although the perioperative management has been optimised over the past few decades, there has not been a remarkable improvement in the mortality rates of patients with a ruptured abdominal aortic aneurysm (rAAA). The aim of this retrospective trial was to define pre-, intra- and postoperative parameters which influence the perioperative and long-term outcome of patients and which can be modified by the operating team. A retrospective database analysis was performed in 49 patients who had undergone an operation of rAAA in our certified centre of vascular surgery between the beginning of 2006 and the end of 2012.

Mapping of autogenous saphenous veins as an imaging adjunct to peripheral MR angiography in patients with peripheral arterial occlusive disease and peripheral bypass grafting: prospective comparison with ultrasound and intraoperative findings.

Background: Mapping of the great saphenous vein is very important for planning of peripheral and coronary bypass surgery. This study investigated mapping of the great saphenous vein as an adjunct to peripheral MR angiography using a blood pool contrast agent in patients who were referred for evaluation of peripheral arterial occlusive disease and bypass surgery.

Methods: 38 patients with peripheral arterial occlusive disease (21 men; mean age: 71 years, range, 44-88 years) underwent peripheral MR angiography using the blood pool contrast agent Gadofosveset trisodium.

0.125 mm(3) spatial resolution steady-state MR angiography of the thighs with a blood pool contrast agent using the quadrature body coil only at 1.5 Tesla.

Purpose: To implement and evaluate high spatial resolution three-dimensional MR contrast-enhanced angiography (3D-CEMRA) of the thighs using a blood pool contrast agent (BPCA) using the quadrature body coil only in patients with peripheral arterial occlusive disease (PAOD) in cases receiver coils cannot be used at 1.5 Tesla (T).

Materials And Methods: Nineteen patients (mean age: 68.

Interventional exclusion of iliac artery aneurysms using the flow-diverting multilayer stent.

Purpose: This study was designed to evaluate retrospectively the results of complex iliac artery aneurysm (IAA) exclusion using the Cardiatis-Multilayer-Stent.

Methods: Between October 2010 and August 2012, ten IAAs were treated in eight males (mean age 75 (59-91) years) using the Multilayer Stent. All IAA exceeded a diameter of 3 cm or were symptomatic.

Using the multilayer stent as a supplement to EVAR in combined abdominal aortic aneurysm and iliac artery aneurysm with inadequate distal landing zone--a case report.

Combined abdominal aortic aneurysm (AAA) and iliac artery aneurysm (IAA) is a common condition. The recently approved Cardiatis Multilayer stent (Cardiatis, Isnes, Belgium) is an innovative stent system for peripheral aneurysm management that has been applied in several clinical cases. After deployment, the unique stent design reduces mean velocity and vorticity within the aneurysm sac, causing thrombus formation and thus exclusion of the aneurysm while the vessels branching from the aneurysm remain patent.

Simultaneous MR arteriography and venography with blood pool contrast agent detects deep venous thrombosis in suspected arterial disease.

Objective: The purpose of this study was to investigate the prevalence of incidental deep venous thrombosis (DVT) in patients with clinically suspected peripheral arterial occlusive disease (PAOD) using contrast-enhanced MR angiography (MRA) with a blood pool contrast agent.

Subjects And Methods: Two hundred fifty-nine MRA examinations with blood pool contrast agent in 245 consecutive patients (161 men; age range, 36-92 years), yielding a total of 4102 assessable arterial and venous vessel segments, were assessed with regard to the rate of incidentally observed acute and organized DVT and arterial stenosis grades. Incidental DVT was confirmed using duplex ultrasound.

Endovascular management of complex renal artery aneurysms using the multilayer stent.

Since its approval as an innovative stent system for peripheral aneurysm management in May 2009, the Cardiatis Multilayer Stent (Cardiatis, Isnes, Belgium) has been applied in several clinical cases. The unique design of this multilayer stent decreases mean velocity and vorticity within the aneurysm sac immediate and causes thrombus to form, resulting in physiological exclusion of the aneurysm from the circulation, whereas branches and collaterals sprouting from the aneurysm remain patent. Here we present a case of a complex renal artery aneurysm successfully treated with a 6×30-mm Cardiatis Multilayer Stent.

Aortobifemoral embolism in an 18-year old patient following cisplatin and 5-fluorouracil chemotherapy for nasopharyngeal carcinoma.

After cisplatin / 5-fluorouracil chemotherapy for nasopharyngeal carcinoma, an 18-year female patient developed aortobifemoral embolism. Besides chemotherapy, additional risk factors for arterial thromboembolic events were smoking, contraceptive medication and adjuvant antiemetic treatment with dexamethasone. Thrombophilia screening was negative.

Highly undersampled supraaortic MRA at 3.0 T: initial results with parallel imaging in two directions using a 16-channel neurovascular coil and parallel imaging factors up to 16.

Purpose: To present the feasibility of highly undersampled contrast-enhanced MRA (CE-MRA) of the supraaortic arteries with a 16-channel neurovascular coil at 3.0 T using parallel imaging in two directions with parallel imaging factors (PIF) up to 16.

Materials And Methods: Institutional review board approval and informed consent were obtained.

Peripheral MR angiography with blood pool contrast agent: prospective intraindividual comparative study of high-spatial-resolution steady-state MR angiography versus standard-resolution first-pass MR angiography and DSA.

Purpose: To prospectively compare the accuracy of high-spatial-resolution steady-state magnetic resonance (MR) angiography with standard-resolution first-pass MR angiography in the lower extremities, with digital subtraction angiography (DSA) as the reference standard.

Materials And Methods: Institutional ethics committee approval and written informed consent were obtained. Twenty-seven patients (16 men, 11 women; mean age, 64.

Magnetic resonance angiography in the follow-up of distal lower-extremity bypass surgery: comparison with duplex ultrasound and digital subtraction angiography.

Purpose: The danger of limb loss as a consequence of acute occlusion of infrapopliteal bypasses underscores the requirement for careful patient follow-up. The objective of this study was to determine the agreement and accuracy of contrast material-enhanced moving-table magnetic resonance (MR) angiography and duplex ultrasonography (US) in the assessment of failing bypass grafts. In cases of discrepancy, digital subtraction angiography (DSA) served as the reference standard.

Endovascular repair of inflammatory abdominal aortic aneurysms: a valuable alternative?--Case report and review of literature.

While endovascular repair (ER) has become a routine procedure in the treatment of arteriosclerotic abdominal aortic aneurysms with a suitable configuration, only rare reports of interventional treatment of inflammatory aortic abdominal aneurysms (IAAA) exist. We present a case study of a male patient with IAAA, who presented with inflammatory thickening involving the entire circumference of the aortic vessel wall. The MRI performed 8 months after successful ER demonstrated complete regression of vessel wall induration.

Results of perioperative measurements of ankle-brachial index in popliteal artery entrapment syndrome.

Objective: The purpose of this study was to demonstrate whether there is postoperative improvement in blood flow in the affected limb after surgical decompression in popliteal artery entrapment syndrome (PAES). For this purpose, the simple method of measuring Doppler ankle pressure with and without provocation was used preoperatively and postoperatively.

Patients And Methods: Doppler ankle pressure was measured preoperatively and postoperatively in neutral position (n=32) and with provocation (forced plantar flexion of the foot; n=32) in 32 limbs in 23 patients with PAES (19 men, 4 women; average age, 38.

[Value of MR angiography in follow-up after cruro-pedal bypass surgery].

Patients after crural or pedal revascularization need a consequent surveillance to prevent graft failure. We compared the results of the clinical examination including duplexscanning with contrast-enhanced magnetic resonance angiography (MRA). 26 bypass grafts were evaluated for potential stenosis in five locations.

[Stage-adapted therapy concept in ascending thrombophlebitis].

Varicophlebitis is the most frequent and important acute complication of a varicosed long and/or short saphenous vein. In view of the controversial discussion about the either conservative or surgical treatment, a clinically relevant classification of this syndrome appears useful: Stage I includes varicophlebitis without involvement of the respective junctional valve--in the groin or at the knee--and deep veins. While in Stage II the proximal part of the thrombus has reached the respective junctional valves of the long or short sapheneous vein, in Stage III it has entered the deep veins by means of these valves.

Collagen patch coated with fibrin glue components. Treatment of suture hole bleedings in vascular reconstruction.

Background: Bleeding from suture holes during vascular reconstruction, particularly when polytetrafluoroethylene (PTFE) prostheses are used, is still a problem which can lead to intraoperative delay and increased blood loss. The aim of this prospective, randomised, open, controlled multicentre study was to evaluate whether the use of a new local haemostyptic would reduce intraoperative blood loss and the time to haemostasis.

Methods: Thirty patients received a new haemostyptic (TachoComb H, Nycomed Pharma AG), whereas another 30 patients were treated with compresses.

[Ascending varicose vein phlebitis--classification and therapy].

Ascending varicophlebitis can cause pulmonary embolism by entering the deep venous system. Classification into four stages permits a differentiated therapeutic strategy: if the thrombus reaches or enters the deep venous system, immediate surgery consisting of crossectomy, resection of the saphenous vein, radical excision of all varicosed veins and ligature of insufficient perforating veins are indicated.

[Simultaneous vascular and endovascular surgery of complex vascular diseases].

Complex vascular disease requires combined, intraoperative endovascular and reconstructive therapy. Hereby, transprosthetic, transluminal angioplasty is particularly well suited for this purpose. The 5-year patency rate after combined inguinal patch plasty and femoral balloon dilation (n = 58) was 70%.